Table 1.

Summary of the included studies.

Author, Year, Location	Context	Study Design, Instruments	Number of Participants	Aim	Analysis	Results
Abdollahyar, et al., 2019 (Iran)	An educational hospital affiliated with Kerman University (noncritical vs. critical care).	A cross-sectional design. The Spirituality and Spiritual Care Rating Scale was used (23 items)	125 nurses	To determine nurses’ attitudes toward spirituality and spiritual care in an educational hospital in Iran.	To analyze data, descriptive statistics were used. The Kolmogorov–Smirnov test was conducted to indicate that data were sampled from a population with a normal distribution. The correlation between demographic data and spirituality and spiritual care mean score was examined by the Pearson and Spearman correlation coefficients, t-test, and one-way ANOVA, using the (SPSS Version 21.0. Armonk, NY, USA: IBM Corp).	A significant association was found between nurses’ spirituality/spiritual care attitudes and age, education level, and type of hospital ward employment (noncritical vs. critical care). Nurses’ scores on attitudes toward spirituality and spiritual care suggest the need for more education in this area.
Atarhim et al., 2018 (Malaysia)	All nurses from the Malaysian Nurse Forum Facebook closed group.	An online survey A descriptive cross-sectional study design. The Spirituality and Spiritual Care Rating Scale (SSCRS) (McSherry, Draper, and Kendrick, 2002). (17 items).	208 nurses	To explore Malaysian nurses’ perceptions of spirituality and spiritual care.	The Malaysian Nurse Forum Facebook closed group was used for data collection with 208 completed questionnaires. The Qualtrics software was utilized.	The participants considered that spirituality is a fundamental aspect of nursing. Half of the respondents were uncertain regarding the use of the spiritual dimension for individuals with no religious affiliation. Most nurses felt that they required more education and training relating to spiritual aspects of care, delivered within the appropriate cultural context.
Chew et al., 2016 (Singapore)	Acute care hospital.	A cross-sectional, exploratory, nonexperimental study. Spiritual Care Giving Scale (SCGS Tiew & Creed, 2012), 35 items.	767 nurses	To investigate acute care nurses’ perceptions of spirituality and spiritual care and relationships with nurses’ personal and professional characteristics.	Descriptive statistics and General Linear Modelling were used to analyze data. SPSS 20.0 Mac version (SPSS Inc., Singapore city, Singapore) was used for data analysis.	Acute care nurses reported positive perceptions of spirituality and spiritual care. Religion, area of clinical practice and view of self as spiritual were associated with nurses’ reported perspectives of spirituality and spiritual care.
Cooper et al., 2020 (Australia)	A nondenominational public hospital and a faith-based private hospital.	Qualitative Critical discourse analysis.	20 nurses	To uncover how nurses construct their understanding of spirituality and practice of spiritual care.	Data were analyzed following the qualitative critical discourse analysis procedure proposed by Schneider.	Three discursive constructions of spirituality were identified: personal religious beliefs, holistic discourse, and empathetic care discourse. The work environment had an influence too.
Deal & Grassley 2012 (USA)	Acute and chronic hemodialysis settings.	Phenomenological design.	10 nurses	To explore the lived experiences of nephrology nurses giving spiritual care in acute and chronic hemodialysis settings.	Data were analyzed using Colaizzi’s phenomenological approach.	Five themes were identified: (a) drawing close, (b) drawing from the well of my spiritual resources, (c), sensing the pain of spiritual distress, (d) lacking resources to give spiritual care and, (e) giving spiritual care is like diving down deep
Lee & Kim 2020 (Korea)	Acute care hospital.	Qualitative analysis based on focus groups.	24 nurses	Analyze the experiences of acute care hospital nurses’ on spiritual care.	Data were analyzed following the qualitative content analysis procedure proposed by Graneheim and Lundman.	Five categories with 14 sub-categories emerged: (1) ambiguous concept: confusing terms, an additional job; (2) assessment of spiritual care needs: looking for spiritual care needs, not recognizing spiritual care needs; (3) spiritual care practices: active spiritual care, passive spiritual care; (4) outcomes of spiritual care: comfort of the recipient, comfort of the provider; and (5) barriers to spiritual care: fear of criticism from others, lack of education, lack of time, space constraints, and absence of a recording system.
Gallison et al., 2013 (USA)	The units included oncology, critical care, geriatrics, and the general medical units at an 800-bed academic medical center in New York City.	An explorative, descriptive study. The Spiritual Care Practice (SCP) Questionnaire (Vance, 2001).	120 nurses	To identify barriers in providing spiritual care to hospitalized patients.	Data were analysed using SAS software program, version 9.2	The most common perceived barrier identified was insufficient time, then privacy religion, then difficulty distinguishing proselytizing from the delivery of spiritual care.
Janzen et al., 2019 (Canada)	Various practice settings across the healthcare continuum.	Qualitative secondary analysis.	14 nurses	To explore the perspectives of nurses regarding influences on spiritual caregiving in nursing practice.	Data were analysed using content analysis. In keeping with the method of secondary analysis, transcripts were sorted to (1) fit with the secondary research questions, (2) achieve detailed description of the phenomenon of interest, and (3) provide maximum variation in the data.	Three nested themes were identified as influencing spiritual caregiving: the nurse as custodian of spiritual caregiving, the influence of practice environments and the social context.
Kaddourah et al., 2018 (Saudi Arabia)	Five tertiary care hospitals in Riyadh (Saudi Arabia).	A cross-sectional study design. The Spirituality and Spiritual Care Rating Scale (SSCRS) (Mcsherry, Draper, and Kendrick, 2002). (17 items).	978 nurses	To identify the perceptions towards spirituality and spiritual care.	Data were analysed using SPSS Statistics (Version 23.0. Armonk, NY, USA: IBM Corp).	The participants believed that spirituality exists in all religions and spiritual care means showing concern while serving the patients and focusing on respecting patients’ religious beliefs.
McSherry & Jamieson 2013 (UK)	Members of the Royal College of Nursing practicing in nursing throughout the United Kingdom.	An online survey Open-ended questions in association with a quantitative survey. SSCRS plus open-ended questions, (17 items).	2327 members of the Royal College of Nursing.	To provide an opportunity for members to express their understandings of spirituality and spiritual care.	Content/thematic analysis. Responses to the survey were automatically collated using the ProQuest platform. A retrospective analysis of the qualitative data was also undertaken. The length of answers provided ranged from ‘no comment’ to extensive descriptions of spirituality and spiritual care.	Five broad themes emerged: (1) theoretical and conceptual understanding of spirituality, (2) fundamental aspects of nursing, (3) notion of integration and integrated care, (4) education and professional development and, (5) religious belief and professional practice. Findings suggest that nurses have diverse understandings of spirituality and the majority consider spirituality to be an integral and fundamental element of the nurses’ role.
Melhem et al., 2016 (Jordan)	Four main sectors; University Affiliated Hospitals, private hospitals, governmental hospitals affiliated to the Ministry of Health and military hospitals affiliated to the Royal Medical Services.	A cross-sectional descriptive study.	408 nurses	To describe nurses’ perceptions of spirituality and spiritual care in Jordan, and to investigate the relationship between nurses’ perceptions and their demographic variables.		Most of the participating nurses had a high level of spirituality and spiritual care perception. Significant differences were found between male and female nurses’ perceptions of spirituality and spiritual care (p < 0.05); previous attendance of courses on spiritual care also made a significant difference to perceptions (p < 0.05).
Pesut & Reimer-Kirkham 2010 (Canada)	Palliative, hospice, medical and renal inpatient units at two tertiary level hospitals and seven community hospitals.	A qualitative study: critical ethnography.	20 health care professionals (nurses, doctors, social workers and other allied health professionals), 17 spiritual care providers (both paid and volunteer), 16 patients/families, and 12 administrators.	To analyze the negotiation of religious and spiritual plurality in clinical encounters, and the social, gendered, cultural, historical, economic and political contexts shape that negotiation. (1) describe how religious and spiritual plurality is negotiated in health care provider/recipient encounters. (2) examine how health care contexts shape the negotiation of religious and spiritual plurality and, (3) critically examine the ways in which societal contexts shape the negotiation of religious and spiritual plurality in health care. The findings pertaining to the first objective, the negotiation of religious and spiritual plurality in clinical encounters.	Data collection, management and analysis occurred concurrently. Interviews were audio-taped and transcribed verbatim. Transcripts and field notes were entered into the NVIVO QSR qualitative software program for analysis.	Clinical encounters between care providers and recipients were shaped by how individual identities in relation to religion and spirituality were constructed. Importantly, these identities did not occur in isolation from other lines of social classification such as gender, race, and class. Negotiating difference was a process of seeing spirituality as a point of connection, eliciting the meaning systems of patients, and creating safe spaces to express that meaning.
Reimer-Kirkham et al., 2017 (Canada)	Home health care	Qualitative analysis-based interview, participant observation and focus groups.	46 participants. Health care providers, administrators, clients.	To explore how caregiver/recipient identities are constructed in home health settings. (2) describe how religious, spiritual, and ethnic plurality is negotiated in caregiver/recipient encounters in home settings. (3) examine how home health services shape how religious, spiritual, and ethnic are negotiated; and, (4) analyze how social contexts shape the negotiation of religious, spiritual, and ethnic plurality in providing home health services.	Data were transcribed and entered Nvivo, a qualitative data analysis program.	The viewpoints of administrators, clients, and healthcare providers traced a pattern of spiritual and managing differences in the provision of home health. These viewpoints were mediated by commonplace constructions of religion and ethnicity in Canadian society and the political economy of home health.
Reimer-Kirkham, et al., 2012 (Canada)	Two hospitals: palliative, hospice, medical and renal inpatient care units within two tertiary hospitals and seven community hospitals.	Ethnographic method	The 55 participants described their religious affiliations as Christian (n = 35), Sikh (n = 10), Muslim (n = 2), First Nations (n = 2), Atheist (n = 2), Jewish (n = 2), Hindu (n = 1) or Greek Orthodox (n = 1).	To examine the negotiation of religious and spiritual plurality in health care with specific objectives to: (i) describe how religious and spiritual plurality is negotiated in healthcare provider/recipient encounters; (ii) examine ways in which healthcare contexts shape the negotiation of religious and spiritual plurality. (iii) critically analyze ways in which spatial and societal contexts shape the negotiation of the religious and spiritual plurality in health care, and (iv) facilitate knowledge translation into practice, health policy and education.	Data were transcribed and entered Nvivo, a qualitative data analysis program.	The sacred takes form in social and material spaces in hospitals. Sacred spaces included designated ecumenical spaces (formerly called ‘chapels’) and informal sacred spaces created elsewhere (e.g., patient’s bedside). Sacred spaces also involved metaphysical (e.g., a sense of the divine when stepping out into a starry night after attending the death of a patient) or relational (e.g., through interpersonal connections) contexts. These spaces evoked a feeling of a sacredness of space and time—A sense of transcendence, immanence or connectedness in the everyday. That is, space was carved out and set apart from ‘ordinary’ hospital environments to provide an arena for performing controlled ‘extraordinary’ patterns of action.
Sahin & Ozdemir 2016 (Turkey)	A general hospital	A descriptive survey. The Spirituality and Spiritual Care Rating Scale (SSCRS) (McSherry, Draper, and Kendrick, 2002). (17 items)	193 nurses	To investigate the nurses’ views to practicing spiritual care.	Data were analyzed using the SPSS for Windows, version 13.0. Descriptive statistics were used to describe nurses’ demographic characteristics.	All nurses participating were women (100%). Older nurses, married, higher levels of education, work experience, worked longer hours, received education in spiritual care, working in medical departments all tended to score higher on the SSCRS.
Tan et al., 2018 (Turkey)	Faculty of Medicine hospitals in 7 city centers (Toka, Ordu, Samsun, Elazıg, Van, Erzincan, Malatya) located in the Central Black Sea and Eastern Anatolian Regions.	A descriptive study. The Spirituality and Spiritual Care Rating Scale (SSCRS) (McSherry, Draper, and Kendrick, 2002). (17 items).	747 nurses	To explore Turkish nurses’ perceptions of spirituality and spiritual care and to investigate the relationship between their perceptions.	Data were collected by using a “Personal Information Form” and the “Spirituality and Spiritual Care Rating Scale” (SSCRS). Data were analyzed by using mean and percentage calculations in SPSS 16 package program.	The results of the study indicate that the knowledge of the nurses concerning spirituality and spiritual care was insufficient. It is thought that the spiritual aspect of the care services in both vocational education and in-service training should be examined.